Bone Marrow Transplantation
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December (1) 2002, Volume 30, Number 11, Pages 749-752
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Engraftment
Reassessing the definition of myeloid engraftment after autotransplantation: it is not necessary to see 0.5 ´ 109/l neutrophils on 3 consecutive days to define myeloid recovery
M Y Alia, Y Oyamaa, J Monreal, J Winter, M Tallman, L I Gordon, S Williams, S Singhal and J Mehta

Hematopoietic Stem Cell Transplant Program, Division of Hematology/Oncology, Northwestern University Medical School, The Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA

Correspondence to: Dr J Mehta, Division of Hematology/Oncology, Northwestern University Medical School, 676 N St Clair Street, Suite 850, Chicago, IL 60611, USA

aDrs Ali and Oyama contributed equally to this work

Abstract

The time to myeloid recovery after autologous hematopoietic stem cell transplantation (HSCT) is usually defined as the first of 3 consecutive days with an absolute neutrophil count (ANC) of 0.5 ´ 109/l (ANC500). Universal documentation of ANC500 for 3 consecutive days, historically required to ensure robust myeloid recovery, has become difficult with a trend towards early discharge and outpatient HSCT. We studied 90 autografted patients to see how frequently ANC declined after having reached 0.5 ´ 109/l. ANC500 was documented on 2 and 3 consecutive days in 14 and 63 patients, respectively. ANC increased by a median of 213% from the 1st to the 2nd day (rise in 75 and unchanged in two), and by a median of 142% from the 2nd day to the 3rd (rise in 60, unchanged in one, and decline in two; higher than the 1st day in the latter three). The increase from the 1st to the 3rd day was 13-3433% (median, 557%). Thus, in all 63 patients, no decline below ANC500 was seen, and the first day with ANC500 was also the first of 3 consecutive days with ANC500. The remaining 13 patients had repeat counts 2-7 days after the 1st day with ANC500 documenting further increase in ANC with no evidence of failed engraftment. These data show that the first day with ANC500 is also consistently the first of 3 consecutive days with ANC500 in autografted patients. Therefore, the traditional definition of myeloid engraftment should be changed to consider the first day with ANC500 as the day of engraftment without necessarily documenting ANC500 on the subsequent 1-2 days. This simple change in definition has significant implications for how data are reported to transplant registries and how peer-review organizations such as the Foundation for the Accreditation of Hematopoietic Cell Therapy (FAHCT) define completeness of data.

Bone Marrow Transplantation (2002) 30, 749-752. doi:10.1038/sj.bmt.1703741

Keywords

autotransplantation; engraftment; myeloid recovery

Received 18 April 2002; accepted 15 August 2002
December (1) 2002, Volume 30, Number 11, Pages 749-752
Table of contents    Previous  Abstract  Next   Full text  PDF